title: [Intravenous iron during predialysis period improves anemia management and cardiovascular parameters in incident hemodialysis patients].
abstract: Individualized use of iron therapy (IT) and erythropoiesis-stimulating agents (ESA) may effectively correct anemia and its symptoms in CKD patients (Pts). The aim of this retrospective study was to precise the anemia management (AM) in incident HD Pts, and to compare Pts treated by intravenous (i.v.) IT and ESA during predialysis to those treated by oral IT and ESA on AM and cardiovascular parameters during the first year of HD. One hundred and two Pts performed their first dialysis in the unit, mean age 58.5 (15.9) years, 70% males, 27% diabetes. Ninety Pts started with a native arteriovenous fistula. Charlson comorbidity index was 7.3 (3.5). Mortality rate was 3% at one year. Hb level was at start 10.6 (1.7) and at one year 11.7 (1.1) g/dL (P<0.0001). DA injected every 2weeks was at the beginning at 107 (56) μg and then at 61 (46) (P<0.0001). i.v. IT injected every week was at the dosage of 87 (23) mg and then at 57 (40mg) per injection (P<0.001). Out of 102 Pts, 33 received i.v. IT during predialysis. These Pts started dialysis with a better Hb level: 11.1 (1.3) versus 10.4 (1.55) g/dL (P<0.01), had a TSAT at 50.0 (19.2) versus 30.1 (15.2) % (P<0.001), received less ESA 0.58 (0.28) versus 0.82 (0.37) μg/kg per week (P<0.01). More important were the changes on the cardiovascular functions: left ventricular mass at 116 (34) versus 134 (39) g/m(2) (P<0.02), left ventricular ejection fraction at 64.7 (4.4) versus 61.4 (8.7) % (P<0.02) and mean arterial pressure at 104.7 (80) versus 109 (13.2) mmHg (P<0.02). These Pts were also less hospitalized. This study revealed the importance of i.v. IT during predialysis care not only on AM but also on cardiovascular status in HD Pts starting dialysis.
authors.affiliation: Centre de dialyse Diaverum, 11, passage Courtois, 75011 Paris, France. Electronic address: jacques.rottembourg@wanadoo.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Rottembourg
authors.forename: Yves
authors.initials: Y
authors.lastname: Sonigo
authors.forename: Aurélie
authors.initials: A
authors.lastname: Dansaert
authors.forename: Mirela
authors.initials: M
authors.lastname: Diaconita
authors.forename: Alain
authors.initials: A
authors.lastname: Guerin
mesh_terms: D000740:Anemia / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006397:Hematinics; D007501:Iron
keywords: Anemia; Anémie; Darbepoetin alfa; Fer intraveineux; Hemodialysis; Hémodialyse; Iron therapy; Masse ventriculaire gauche